Laparoscopic Colorectal Surgery
The small bowel and the colon are the parts of the intestine that are responsible for the digestion and absorption of the food that we eat. The rectum is responsible for storing our waste. Today, all intestinal procedures for non-cancerous and cancerous conditions affecting these areas of the body can be performed using advanced laparoscopic or endo-luminal techniques.
Minimally Invasive Surgeons were the first surgeons to successfully apply advanced laparoscopic techniques to all conditions of colon and rectum. The first procedures were performed in the early 1990’s soon after the introduction of laparoscopic surgery for gallbladder disease. The colorectal surgical community has been slow to adopt laparoscopic surgical techniques into their practices for a variety of reasons. Today, more than half of the colorectal procedures in the United States are still performed using open or hand assisted techniques.
In my practice, I have performed thousands of colorectal procedures for non-cancerous conditions and colorectal cancer utilizing advanced laparoscopic and endo-luminal techniques since completing my Minimally Invasive Surgery fellowship in 2001. I was the first surgeon in Southern Arizona to perform the more advanced laparoscopic colorectal procedures such as Total Proctocolectomy, Total Abdominal Colectomy, Low Anterior Resection with Meso-rectal Excision, and Trans-anal Endoscopic Microsurgery.
The type of surgery performed is specific to the location of the condition. The procedures can range from simply removing a piece of the small intestine, to removing the appendix, to removing the right, left, or entire colon. For patients with cancer, the procedures include removing the tumors, the tissues around the tumors, and the associated lymph nodes.
The Trans-anal Endoscopic Microsurgical (TEM) procedure is used to remove rectal tumors from the inside out. The surgeon uses a laparoscope and laparoscopic instruments through a tube inserted via the anus into the rectum to remove the tumors. Therefore, there are no skin incisions and little or no pain associated with the procedure. Patients typically spend one night in hospital following the procedure and return to their normal activities in 2-3 days. This technique works very well for non-cancerous tumors and early cancerous tumors that are less than 4 cms in size and have not penetrated into the rectal muscle wall.
The management of larger and deeper rectal cancers involves the performance of a Laparoscopic Total Meso-rectal Resection to remove the rectum and the lymphatic tissue envelope that surrounds the rectum within the pelvis. Depending upon the location of the cancer within the rectum, patients may undergo an anterior resection, low anterior resection with a colo-anal anastomosis, or abdominal-perineal resection.